Chronic venous insufficiency

Chronic venous insufficiency, chronic venous insufficiency, CVI, varicose veins, varicosis.

Edema formation, and irreversible change in the veins, surrounding tissues and muscle fascia due to chronic. Reflux of venous blood.

• Women > men
• Prevalence: 15-50% affected depending on source

• Insufficiency of superficial, deep or transfascial veins
• Emergence is possible in the setting of:
  • Primary varicoses
  • Secondary varicoses
  • Phlebothrombosis
  • A post-thrombotic syndrome

• The examination should always be performed standing up due to the hydrostatic pressure.

• Purpura jaune d'ocre: Due to increased hydrostatic pressure, erythrocyte extravasation occurs with consequent haemosiderin deposition, leading to hyperpigmentation on the lower legs.
• Hypodermatitis: Aseptic, acute inflammation of the cutaneous subcutaneous tissue. This is often painful and occurs with redness and tension (pseudoerysipelas). In the course, transition into dermatoliposclerosis.

• Dermatoliposclerosis: proteins leaking in the context of hydrostatic pressure lead to increased cutaneous and subcutaneous collagen synthesis and fibroblast stimulation.

• Atrophy blanche/ capillaritis alba: Porcelain-coloured scarring healing skin atrophy around the ankles or around an ulcer. There is an increased risk of ulceration.

• Clinic
• Phlebological examination

1. Abu-Own, A., J.H. Scurr, and P.D. Coleridge Smith, Effect of leg elevation on the skin microcirculation in chronic venous insufficiency. Journal of Vascular Surgery, 1994. 20(5): p. 705-710.
2. Beebe-Dimmer, J.L., et al., The Epidemiology of Chronic Venous Insufficiency and Varicose Veins. Annals of Epidemiology, 2005. 15(3): p. 175-184.
3. Chiesa, R., et al., Chronic Venous Insufficiency in Italy: The 24-cities Cohort Study. European Journal of Vascular and Endovascular Surgery, 2005. 30(4): p. 422-429.
4. Coleridge Smith, P.D., Update on Chronic-Venous-Insufficiency-Induced Inflammatory Processes. Angiology, 2001. 52(1 suppl): p. S35-S42.
5. Greenberg, A.S., et al., Acute lipodermatosclerosis is associated with venous insufficiency. Journal of the American Academy of Dermatology, 1996. 35(4): p. 566-568.
6. Jünger, M., et al., Microcirculatory Dysfunction in Chronic Venous Insufficiency (CVI). Microcirculation, 2000. 7(S1): p. S3-S12.
7. Konoeda, H., et al., Quantification of Superficial Venous Reflux by Duplex Ultrasound—Role of Reflux Velocity in the Assessment the Clinical Stage of Chronic Venous Insufficiency. Annals of Vascular Diseases, 2014. 7(4): p. 376-382.
8. Labropoulos, N., The Role of Venous Reflux and Calf Muscle Pump Function in Nonthrombotic Chronic Venous Insufficiency. Arch Surg, 1996. 131(4): p. 403.
9. Marston, W.A., et al., Healing rates and cost efficacy of outpatient compression treatment for leg ulcers associated with venous insufficiency. Journal of Vascular Surgery, 1999. 30(3): p. 491-498.
10. Nicolaides, A.N., Investigation of Chronic Venous Insufficiency : A Consensus Statement. Circulation, 2000. 102(20): p. e126-e163.
11. Peschen, T.L.B.H.M., Expression of the Adhesion Molecules ICAM-1, VCAM-1, LFA-1 and VLA-4 in the Skin is Modulated in Progressing Stages of Chronic Venous Insufficiency. Acta Dermato-Venereologica, 1999. 79(1): p. 27-32.
12. Raju, S. and P. Neglén, Chronic Venous Insufficiency and Varicose Veins. New England Journal of Medicine, 2009. 360(22): p. 2319-2327.
13. Takase, S., G. Schmid-Schönbein, and J.J. Bergan, Leukocyte activation in patients with venous insufficiency. Journal of Vascular Surgery, 1999. 30(1): p. 148-156.
14. Valencia, I.C., et al., Chronic venous insufficiency and venous leg ulceration. Journal of the American Academy of Dermatology, 2001. 44(3): p. 401-424.
15. Weiss, R.A., et al., Comparative outcomes of different endovenous thermal ablation systems on great and small saphenous vein insufficiency: Long-term results. Lasers Surg. Med., 2015. 47(2): p. 156-160.
16. Bunnell AP et al. (2014) Factors Associated with Saphenous Vein Recanalization after Endothermal Ablation. Ann Vasc Surg doi: 10.1016/j.avsg.2014.09.020
17. Carruthers TN et al.(2014) Interventions on the Superficial Venous System for Chronic Venous Insufficiency by Surgeons in the Modern Era: An Analysis of ACS-NSQIP. Vasc Endovascular Surg PubMed PMID: 25487248.
18. Garreau C et al. (1988) Evaluation of venous therapy. Venous tonics, vascular protectants and thermal cures. What are the advantages for the patient? Phlebol 41: 857–876
19. Hesse G, Stiegler H (2003) Ultrasound diagnostic techniques in dermatologic angiology and phlebology. Hautarzt 54: 614-625
20. Kistner RL et al. (1996) Diagnosis of chronic venous disease of the lower extremities: the "CEAP" classification. Mayo Clin Proc 71: 338-345
21. Lentner A et al. (1994) Beweglichkeit im oberen und unteren Sprunggelenk bei fortgeschrittener chronischer Veneninsuffizienz. Phlebol 23: 149–155
22. Proebstle TM (2003) Surgical therapy of venous leg ulcers. Hautarzt 54: 379-386
23. Vanscheidt V et al. (1994) Paratibial Fasciotomy. A new approach for treatment of therapy-resistant venous leg ulcers. Phlebol 23: 45–48
24. Willa-Craps C et al. (1994) Kontaktallergie bei chronischer Veneninsuffizienz Phlebol 24: 93–97
25. Zygmunt JA (2014) Duplex ultrasound for chronic venous insufficiency. J Invasive Cardiol 26: E149-155